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AlQurashi HE, Alzahrani HA, Bafaraj MO, Bosaeed M, Almasabi M, Banhidarah A. Endovascular Repair in Blunt Thoracic Aortic Injury: A 10-Year Single Center Experience. Cureus 2024; 16:e55327. [PMID: 38559515 PMCID: PMC10981867 DOI: 10.7759/cureus.55327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Life-threatening blunt thoracic aortic injury (BTAI) typically occurs alongside multiple other traumatic injuries. Symptoms of BTAI can range from being asymptomatic in the case of intimal tears to becoming catastrophic in the case of uncontained aortic ruptures. The aim of this research was to examine the clinical outcomes for those who underwent thoracic endovascular aortic repair (TEVAR) in hospital settings. Methods: A cross-sectional retrospective study was conducted using patient data that were extracted from Al-Noor Specialist Hospital, Makkah, Saudi Arabia, for the duration between January 2011 and December 2021. This study included data from all patients aged 18 and up who had been diagnosed with BTAI and had undergone TEVAR. The BTAI diagnoses were confirmed using CT scans. Logistic regression was utilized to identify predictors of patients' health status improvement and length of stay. RESULTS A total of 80 patients were involved. Around 50.0% (n=40) of the patients had grade 3 thoracic aortic injuries. The median duration of stay was 14.00 days (Interquartile range 21.00). Only one patient developed post-procedure complications (1.3%). Almost one-third (31.3%; n=25) of the patients required subclavian coverage. One patient developed intraoperative endoleak (1.3%). One patient developed an access site complication (1.3%). The mortality rate within 30 days of the operation was 1.3%. The vast majority of the patients (92.5%; n=74) showed improvement upon discharge from the hospital. The baseline patient characteristics and length of hospitalization had no effect on the improvement of patient status upon discharge or their length of stay (p>0.05). CONCLUSION Patients with BTAI have shown an excellent success rate with TEVAR and a low complication rate. Predictors of procedure success and length of stay need to be identified; however, this can't be done without larger-scale investigations. This can aid in the development of preventative measures that improve clinical outcomes for the patients.
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Affiliation(s)
| | | | | | - Mohammed Bosaeed
- Vascular and Endovascular Surgery, Alnoor Specialist Hospital, Makkah, SAU
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2
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Bayona JG, Rey Chaves CE, Hernández Rodríguez OG, Barón V, Fajardo E, Posada E. Case report: Endovascular stent-graft repair of aortic penetrating trauma, literature review, and case report. Front Surg 2023; 10:1264558. [PMID: 37886635 PMCID: PMC10598695 DOI: 10.3389/fsurg.2023.1264558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Penetrating aortic injuries are infrequent. Its incidence is unknown because most patients die of hemorrhage even before they receive adequate treatment. Aortic wounds generally require conventional thoracotomy/laparotomy repair and are related to high mortality rates. Recently with the advent of endovascular techniques, most authors prefer endovascular management when feasible due to better (still poor) outcomes. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Here we present the diagnosis and treatment of a 30 years-old male patient with multiple traumatic stab wounds, including anterior aortic laceration with a grade II aortic lesion successfully managed with an endovascular stent graft.
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Affiliation(s)
| | - Carlos Eduardo Rey Chaves
- Estudiante de Posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | - Oscar Geovanny Hernández Rodríguez
- Cirugía Vascular Periférica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Vladimir Barón
- Cirugía Vascular Periférica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Ernesto Fajardo
- Cirugía Vascular Periférica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Eduardo Posada
- Estudiante de Posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
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3
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Benz RM, Makaloski V, Brönnimann M, Mertineit N, von Tengg-Kobligk H. [Diagnostics and treatment of traumatic aortic injuries]. Unfallchirurg 2021; 124:601-609. [PMID: 34254152 PMCID: PMC8370906 DOI: 10.1007/s00113-021-01044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Traumatische Aortenverletzungen (TAV) sind seltene Folgen von stumpfen Traumata, die eine hohe Mortalität und Morbidität aufweisen. Die schnelle und akkurate Diagnostik sowie die Wahl der korrekten Therapie sind für das Patientenüberleben elementar. Fragestellung Bestimmung des aktuellen Standards der Abklärung von TAV im akuten Trauma-Setting und Evaluation der aktuellen Leitlinien zur Therapie. Material und Methode Eine Literaturrecherche wurde durchgeführt, mit der Suche nach Publikationen, die die Abklärung und Diagnostik der TAV beschreiben. Außerdem wurden Leitlinien für die Behandlung und Nachsorge von TAV zusammengefasst. Ergebnisse In der Literatur wird trotz geringer Spezifität eine konventionelle Thoraxröntgenaufnahme als Initialdiagnostik genannt. Es sollte primär, als Modalität der Wahl, zur Diagnostik und zur Therapiestratifizierung eine Computertomographie (CT) aufgrund der hohen Sensitivität und Spezifität nachfolgen. In allen Leitlinien ist die thorakale endovaskuläre Aortenrekonstruktion („thoracic endovascular aortic repair“, TEVAR) die Therapie der Wahl bei höhergradigen TAV (Grade II–IV) und hat die offene Chirurgie in dem meisten Fällen abgelöst. Schlussfolgerung Nach einer kurzfristig erfolgten CT-Diagnostik und Einteilung wird die TEVAR der offenen Chirurgie bei therapiebedürftigen TAV vorgezogen.
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Affiliation(s)
- R M Benz
- Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz.
| | - V Makaloski
- Universitätsklinik für Herz- und Gefäßchirurgie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz
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4
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López Espada C, Linares Palomino JP, Domínguez González JM, Iborra Ortega E, Lozano Vilardell P, Solanich Valldaura T, Volo Pérez G, Blanco Cañibano E, Álvarez Salgado A, Fernández Fernández JC, Hernando Rydings M, Miralles Hernández M. A multicenter study of emergency endovascular repair of the thoracic aorta: Indications and outcomes. Med Intensiva 2021; 45:280-288. [PMID: 34059218 DOI: 10.1016/j.medine.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/28/2019] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA 1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES Patient mortality, survival and reoperation rate. SECONDARY VARIABLES Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.
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Affiliation(s)
- C López Espada
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J P Linares Palomino
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - E Iborra Ortega
- Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Lozano Vilardell
- Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - G Volo Pérez
- Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, Spain
| | - E Blanco Cañibano
- Servicio de Cirugía Vascular, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - A Álvarez Salgado
- Servicio de Cirugía Vascular, Hospital Universitario de Cabueñes, Spain
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5
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Efficacy and Safety of Heparinization before Deployment of Endograft for Blunt Traumatic Aortic Injury in Severely Injured Patients. Ann Vasc Surg 2021; 75:341-348. [PMID: 33556520 DOI: 10.1016/j.avsg.2021.01.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The administration of unfractionated heparin (UFH) during endovascular repair of blunt traumatic aortic injury (BTAI) is controversial. The aim of the study is to report the early outcomes of patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI, and to assess the individualized intraoperative use and dose of UFH. METHODS This is a retrospective analysis including consecutive patients treated with TEVAR for BTAI of the descending aorta between January 1st, 2005 and December 31st, 2018. Intraoperative use and doses of UFH were analyzed. Primary outcome included a reintervention because of new onset bleeding and/or thromboembolic complication and 30-day mortality. Technical success, injury severity score (ISS), timing of treatment, and neurologic deterioration were secondary outcome. RESULTS Thirty-six patients with a mean age of 47 ± 18 years, 30 males (83%), were included. Intraoperative administration of UFH was recorded in 30/36 patients (83%) with a mean dose of 4750 ± 2180 IU. Two patients had no UFH because of extensive intracranial hemorrhage or suspected relevant liver laceration, respectively; 1 died in theatre, 1 was already anticoagulated having a mechanical aortic valve, and in 2 no information about heparin use was found. During 30 days of follow-up, 3 patients died (8%; 3/36): 1 patient with completely transected aorta died on-table and 2 on the fifth postoperative day, 1 from trauma-associated brain injury and 1 with multi organ failure. No bleeding or thromboembolic complication requiring reintervention occurred in any patient during 30 days follow-up. In 3 patients partial unintentional coverage of the left common carotid artery occurred, resulting in technical success of 89% (32/36). Mean ISS was 43 ± 15. Thirty-five patients (97%) were severely injured having an ISS ≥ 25. Twenty-nine patients (81%) were treated within 24 hr and 6 patients (17%) within 1 week. No stroke or spinal cord ischemia was observed. CONCLUSIONS Systemic heparinization in different doses during TEVAR for BTAI can be safe with no intraoperative bleeding or thromboembolic complications in early postoperative period.
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6
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Hybrid management of aortic arch trauma: case report. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Cheng D, McNickle AG, Fraser DR, Carroll JT, Vega JA, Dickhudt T, Bombard J, Kuhls DA, Chestovich PJ. Early Characteristics and Progression of Blunt Traumatic Aortic Injuries at a Single Level I Trauma Center. Vasc Endovascular Surg 2020; 55:105-111. [PMID: 33063647 DOI: 10.1177/1538574420966450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The most widely accepted grading system for blunt traumatic aortic injury (BTAI) by the Society of Vascular Surgery (SVS) recommends endovascular repair for grade 2 and greater. Non-operative management in grade 2 injuries has been shown to be reasonable in certain circumstances. The natural history of low-grade injuries (1, 2) when managed non-operatively is not well defined. METHODS Utilizing our trauma registry, patients from 2013 to 2016 with blunt traumatic injury who underwent initial computed tomography were identified. Aortic pathology was graded and grouped by SVS classification. Clinical courses were reviewed for timing of interventions, repeat imaging, concurrent injuries, and outcomes. Analysis of variance and Chi-square tests of significance were utilized to compare between groups. RESULTS Out of 10,178 patients, we identified 32 with BTAI (grade: 1 (n = 13), 2 (n = 5), 3 (n = 3), 4 (n = 11)). High-grade injuries (3, 4) resulted only from motor vehicle, motorcycle, and pedestrian mechanisms. Initially, 9 patients (28%) required intervention, 5 (16%) were treated non-operatively, and 18 (56%) underwent repeat imaging. On repeat imaging, injuries that did not resolve remained stable and no injuries were found to progress. Of these patients, 9 (50%) required delayed intervention and 9 (50%) successfully underwent non-operative management. Patients with low-grade injuries were more likely to have successful non-operative management than those with high-grade injuries (72% vs 7%; p < 0.01). CONCLUSIONS While low-grade injuries generally have good outcomes, some ultimately do require delayed intervention, and short-term imaging is not reliable in identifying these cases.
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Affiliation(s)
- Daniel Cheng
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | | | - Douglas R Fraser
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Joseph T Carroll
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Jorge A Vega
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Timothy Dickhudt
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Judzia Bombard
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Deborah A Kuhls
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Paul J Chestovich
- University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
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Abstract
BACKGROUND Our aim was to identify predictors of mortality and limb loss in iatrogenic and civilian arterial trauma. METHODS Cases were identified by searching prospectively maintained registries. Multivariable logistic regression was used to identify independent outcome predictors. RESULTS During the study period, 285 patients with arterial trauma were managed with endovascular (n = 20) or open (n = 265) repair. Iatrogenic injuries increased in frequency during the course of the study, from 23.9% during the first decade to 35.9 and 55.7% during the second and third decade, respectively (p < 0.001). Endovascular management increased in frequency during the course of the study, from 0% during the first decade to 5.1 and 11.1% during the second and third decade, respectively (p = 0.005). Mortality was 9.8%, and limb loss (in cases with injury of the aorta or limb arteries, n = 259) was 6.2%. Independent predictors of mortality included increased age (odds ratio, 95% confidence interval [OR, 95% CI] 1.05 (1.02-1.07), p < 0.001), blunt trauma (OR [95% CI] 4.8 (1.9-12.2), p = 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.25 (1.1-1.4), p = 0.001). Independent predictors of limb loss included the first half of the study period (OR [95% CI] 3.9 (1.1-14.1), p = 0.04), lower extremity arterial trauma (vs upper extremity, aortic, common or external iliac artery trauma, OR [95% CI] 8.3 (1.9-35.7), p = 0.004), bone fracture (OR [95% CI] 16.9 (4.7-62.5), p < 0.001) and the number of RBC units transfused intraoperatively (OR [95% CI] 1.16 (1.02-1.33), p = 0.024). CONCLUSION Increasingly iatrogenic in cause and managed by endovascular methods, arterial trauma remains a problem associated with significant mortality and limb loss. Identification of unfavourable outcome predictors may help clinicians involved with arterial trauma to escalate the level of care.
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Beliaev AM, Bergin CJ, Webster MWI, Haydock DA. Surgical repair after failed thoracic endovascular aortic repair for severe blunt traumatic descending thoracic aorta injury in a young patient. ANZ J Surg 2020; 91:211-213. [PMID: 32531106 DOI: 10.1111/ans.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Andrei M Beliaev
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Colleen J Bergin
- Anatomy with Medical Imaging FMHS University of Auckland, Auckland, New Zealand
| | - Mark W I Webster
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - David A Haydock
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
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Martinelli O, Malaj A, Faccenna F, Ruberto F, Alunno A, Totaro M, Irace L. Open Conversion for Recurrent Endograft Occlusion after Endovascular Treatment of Blunt Traumatic Aortic Injury: A Peculiar Case Report. Ann Vasc Surg 2020; 67:568.e1-568.e8. [PMID: 32234576 DOI: 10.1016/j.avsg.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We report a rare case of delayed, symptomatic thoracic endograft thrombosis after the initial thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury which was successfully retreated with a redo TEVAR, followed by open conversion due to recurrent partial occlusion of the distal edge of the endografts. METHODS Two years ago, a 22-year-old man had undergone an emergency TEVAR for blunt thoracic aortic injury. A Zenith Cook 22 × 100 mm (Cook Incorporated, Bloomington, IN) endograft was used. Six months later, he underwent an emergency endovascular relining of the endograft using the same type of device. The multiorgan perfusion was completely restored except for the spinal cord injury. After 8 months, a recurrent partial occlusion of the distal edge of the second graft was documented. The thoracic aorta was replaced with a 22-mm silver-coated graft (Maquet Spain, SLU). RESULTS Histology examination showed a neointimal formation and thickening and fibrosis of the inner 1/3 of the media with loss of smooth muscle cells and increase of the elastic fibers. CONCLUSIONS The need for secondary interventions or open conversion because of potential complications after TEVAR for traumatic aortic injury is an additional consideration when weighing the risks and benefits of endovascular repair and subsequent surveillance strategies.
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Affiliation(s)
| | - Alban Malaj
- American Hospital, Laprake, Tirana, Albania.
| | - Federico Faccenna
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Franco Ruberto
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, "Sapienza" University of Rome, Rome, Italy
| | - Alessia Alunno
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Marco Totaro
- Department of the Heart and Great Vessels, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Irace
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
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López Espada C, Linares Palomino JP, Domínguez González JM, Iborra Ortega E, Lozano Vilardell P, Solanich Valldaura T, Volo Pérez G, Blanco Cañibano E, Álvarez Salgado A, Fernández Fernández JC, Hernando Rydings M, Miralles Hernández M. Endovascular Treatment of Descending Thoracic Aortic Pathology: Results of the Regis-TEVAR Study. Ann Vasc Surg 2020; 67:306-315. [PMID: 32173472 DOI: 10.1016/j.avsg.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/12/2020] [Accepted: 02/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology. The objective of this study was to analyze indications and results of thoracic endovascular aortic repair (TEVAR) in vascular surgery units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS From 2012 to 2016, a total of 287 patients from 11 vascular surgery units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival, and reintervention rate. The following indications for TEVAR were also analyzed: aortic dissections, thoracic aneurysms, traumatisms, and intramural hematomas or penetrating ulcers, as well as results and postoperative complications in accordance with each indication. RESULTS Of the 287 TEVAR performed (239 men, mean age 64.1 ± 14.1 years), 155 were because of aortic aneurysm (54%), 90 because of type B aortic dissection (31.4%), 36 because of traumatic aortic rupture (12.5%), and 6 because of penetrating ulcers or intramural hematomas (2.1%). Overall mortality at 30 days was 11.5% (18.5% in urgent and 5.3% in elective), being higher in dissections (13.3%). The median actuarial survival was 73% at 4 years. The stroke rate was 3.1%, and the rate of spinal cord ischemia was 4.9%. Aortic reoperations were necessary in 23 patients (8.1%). CONCLUSIONS This registry provides complete and reliable information on real clinical practice of TEVAR in Spain, with results similar to international series of open surgery. In accordance with these data, TEVAR can be performed with acceptable morbidity and mortality and with low rates of postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | - Guido Volo Pérez
- Vascular Surgery Unit, University Hospital Dr.Negrín de Gran Canaria, Spain
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12
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Abstract
ZusammenfassungVerkehrsunfälle sind für den größten Teil der traumatischen Aortenrupturen verantwortlich, meist zusammen mit weiteren schweren Begleitverletzungen. Die prähospitale Sterblichkeit ist hoch. Bei Verdacht auf eine beteiligte Aortenverletzung, aufgrund eines hohen traumatic aortic injury scores, ist eine Computertomographie durchzuführen. Es erfolgt eine Triage der Verletzungen, und die Versorgungspriorität der Aorta richtet sich nach dem Schweregrad der Aorten- und Begleitverletzungen sowie dem Zustand des Patienten. Bis zur definitiven Versorgung der aortalen Läsion muss der Blutdruck konsequent gesenkt werden. Grad I und II können in Einzelfällen unter enger Kontrolle inital konservativ gemanagt werden. Grad III (gedeckte Ruptur) und Grad IV (freie Ruptur) benötigen eine raschestmögliche Versorgung (interventionell, chirurgisch). In ausgesuchten Fällen kann auch eine verzögerte Versorgung günstig sein.Als bevorzugte Versorgungsform hat sich die interventionelle Stentgrafttherapie etabliert.
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13
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López Espada C, Linares Palomino JP, Domínguez González JM, Iborra Ortega E, Lozano Vilardell P, Solanich Valldaura T, Volo Pérez G, Blanco Cañibano E, Álvarez Salgado A, Fernández Fernández JC, Hernando Rydings M, Miralles Hernández M. A multicenter study of emergency endovascular repair of the thoracic aorta: indications and outcomes. Med Intensiva 2019; 45:280-288. [PMID: 31836259 DOI: 10.1016/j.medin.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA 1) Ruptured descending thoracic aortic aneurysms; 2) Blunt traumatic thoracic aortic injury; and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES Patient mortality, survival and reoperation rate. SECONDARY VARIABLES Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the ruptured descending thoracic aortic aneurysms group (27.9%). The mean actuarial survival rate was 67± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.
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Affiliation(s)
- C López Espada
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - J P Linares Palomino
- Servicio de Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - E Iborra Ortega
- Servicio de Cirugía Vascular, Hospital Universitari de Bellvitge, Barcelona, España
| | - P Lozano Vilardell
- Servicio de Cirugía Vascular, Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - G Volo Pérez
- Servicio de Cirugía Vascular, Hospital Universitario Dr. Negrín, Gran Canaria, España
| | - E Blanco Cañibano
- Servicio de Cirugía Vascular, Hospital Universitario de Guadalajara, Guadalajara, España
| | - A Álvarez Salgado
- Servicio de Cirugía Vascular, Hospital Universitario de Cabueñes, España
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14
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Carter R, Wee IJY, Petrie K, Syn N, Choong AM. Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review. Vascular 2018; 27:204-212. [PMID: 30522411 DOI: 10.1177/1708538118812548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Whilst the management of blunt traumatic thoracic aortic injury has seen a paradigm shift to an 'endovascular first' approach, the limitations of thoracic endovascular aortic repair remain. An inadequate proximal landing zone limits the use of thoracic aortic stent grafts and in an emergent polytrauma setting, aortic arch debranching via open surgery may not be practical or feasible. A wholly endovascular approach to debranching utilising 'off-the-shelf' stents and parallel graft techniques may represent a possible solution. Hence, we sought to perform a systematic review investigating the use of chimney graft techniques alongside thoracic aortic stenting in blunt traumatic thoracic aortic injury. METHODS We performed the systematic review in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on Medline (PubMed), Web of Science and Scopus to identify articles describing the use of chimney grafts in traumatic aortic transection (PROSPERO: CRD42017082549). RESULTS The systematic search revealed 172 papers, of which 88 duplicates were removed resulting in 84 papers to screen. Based on title, abstract and full text review, six articles were included for final analysis. There were nine patients in total with an average age of 41 (three females, five males, one unspecified), all with significant polytrauma, secondary to the mechanism of injury. A variety of stents were used between centres, with techniques showing a predominance to stenting of the left subclavian artery (77%, n = 7). The technical success rate was 82%, with two (18%) cases of type 1 endoleaks, of which one resolved spontaneously. CONCLUSIONS Despite the encouraging results, this by no means provides for a firm conclusion given the small sample size. Patients should still be judiciously selected on a case-by-case basis when employing the chimney graft technique. Larger cohort studies are needed to establish these findings.
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Affiliation(s)
- Rebeca Carter
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,2 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ian Jun Yan Wee
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kyle Petrie
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,2 Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicholas Syn
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Mtl Choong
- 1 SingVaSC, Singapore Vascular Surgical Collaborative, Singapore, Singapore.,4 Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.,5 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,6 Division of Vascular Surgery, National University Heart Centre, Singapore, Singapore
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Calvo RY, Bansal V, Dunne CE, Badiee J, Sise CB, Sise MJ. A population-based analysis of outcomes after repair of thoracic aortic emergencies in trauma. J Surg Res 2018; 231:352-360. [DOI: 10.1016/j.jss.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/30/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
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Grigorian A, Spencer D, Donayre C, Nahmias J, Schubl S, Gabriel V, Barrios C. National Trends of Thoracic Endovascular Aortic Repair Versus Open Repair in Blunt Thoracic Aortic Injury. Ann Vasc Surg 2018; 52:72-78. [PMID: 29886219 DOI: 10.1016/j.avsg.2018.03.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Blunt thoracic aortic injury (BTAI) occurs in <1% of all trauma admissions. Considering the advent of multiple thoracic endovascular aortic repair (TEVAR) devices over the past decade, improved outcomes of TEVAR supported in the literature, rapid diagnosis, and improved preoperative planning of BTAI using computed tomography imaging, we hypothesized that the national incidence of TEVAR in BTAI has increased while open repair has decreased. In addition, we hypothesized that the mortality risk in BTAI patients undergoing TEVAR would be lower than open repair. METHODS This was a retrospective analysis of the National Trauma Data Bank from 2007 to 2015. The primary end points of interest included the incidence of TEVAR and open repair, as well as mortality in BTAI patients undergoing intervention. Covariates were included in a multivariable analysis to determine risk for mortality in BTAI patients undergoing open repair versus TEVAR. RESULTS We identified 3,628 BTAI patients undergoing intervention. Of these, 3,226 underwent TEVAR (87.9%), and 445 (12.1%) underwent open repair. Compared with open repair, TEVAR had a shorter mean length of stay (LOS) (19.8 vs. 21.3 days, P < 0.05) and lower rates of acute kidney injury (AKI) (5.6% vs. 9.0%, P < 0.05) and mortality (8.8% vs. 12.8%, P < 0.05). Open repair had greater risk for mortality than TEVAR (odds ratio = 1.63, confidence intervals = 1.19-2.23, P < 0.05). CONCLUSIONS The rate of open repair decreased from 7.4% in 2007 to 1.9% in 2015, whereas TEVAR increased from 12.1 to 25.7% during the same time period. We confirmed previous findings that endovascular repair is associated with decreased mortality, LOS, and major complications, including AKI. Future investigations should focus on identifying the ideal patient candidate for TEVAR and elucidate precise indications for TEVAR in BTAI.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA.
| | - Dean Spencer
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
| | - Carlos Donayre
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
| | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA
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The evolution of care improves outcome in blunt thoracic aortic injury: A Western Trauma Association multicenter study. J Trauma Acute Care Surg 2017; 83:1006-1013. [PMID: 28538630 DOI: 10.1097/ta.0000000000001555] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The management of blunt thoracic aortic injury (BTAI) has evolved radically in the last decade with changes in the processes of care and the introduction of thoracic endovascular aortic repair (TEVAR). These changes have wrought improved outcome, but the direct effect of TEVAR on outcome remains in question as previous studies have lacked vigorous risk adjustment and long-term follow-up. To address these knowledge gaps, we compared the outcomes of TEVAR, open surgical repair, and nonoperative management for BTAI. METHODS Eight verified trauma centers recruited from the Western Trauma Association Multicenter Study Group retrospectively studied all patients with BTAI admitted between January 1, 2006, and June 30, 2016. Data included demographics, comorbidities, admitting physiology, injury severity, in-hospital care, and outcome. RESULTS We studied 316 patients with BTAI; 57 (18.0%) were in extremis and died before treatment. Of the 259 treated surgically, TEVAR was performed in 176 (68.0%), open in 28 (10.8%), hybrid in 4 (1.5%), and nonoperative in 51 (19.7%). Thoracic endovascular aortic repair and open repair groups had similar Injury Severity Scale score, chest Abbreviated Injury Scale score, Trauma and Injury Severity Score, and probability of survival, but differed in median age (open: 28 [interquartile range {IQR}, 19-51]; TEVAR: 46 [IQR, 28-60]; p < 0.007), zone of aortic injury (p < 0.001), and grade of aortic injury (open: 6 [IQR, 4-6]; TEVAR: 2 [IQR, 2-4]; p < 0.001). The overall in-hospital mortality was 6.6% (TEVAR: 5.7%, open: 10.7%, nonoperative: 3.9%; p = 0.535). Of the 240 patients who survived to discharge, two died (one at 9 months and one at 8 years); both were managed with TEVAR, but the deaths were unrelated to the aortic procedure. Stent graft surveillance computed tomography scans were not obtained in 37.6%. CONCLUSIONS The mortality of BTAI continues to decrease. Thoracic endovascular aortic repair, when anatomically suitable, should be the treatment of choice. Open repair remains necessary for more proximal injuries. Process improvement in computed tomography imaging in follow-up of TEVAR is warranted. LEVEL OF EVIDENCE Therapeutic/care management, level III.
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Abdoli S, Ham SW, Wilcox AG, Fleischman F, Lam L. Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury. Ann Vasc Surg 2017; 42:305.e7-305.e12. [PMID: 28389290 DOI: 10.1016/j.avsg.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.
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Affiliation(s)
- Sherwin Abdoli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Sung Wan Ham
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Alison G Wilcox
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Lydia Lam
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
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Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Nurs 2016; 22:99-110. [PMID: 25768967 DOI: 10.1097/jtn.0000000000000118] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent of patients with BTAI will die before reaching a trauma center. The issues of how to diagnose, treat, and manage BTAI were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the practice management guidelines on this topic published in 2000. Since that time, there have been advances in the management of BTAI. As a result, the EAST guidelines committee decided to develop updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST. METHODS A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding BTAI from 1998 to 2013. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included imaging to diagnose BTAI, type of operative repair, and timing of operative repair. RESULTS Sixty articles were identified. Of these, 51 articles were selected to construct the guidelines. CONCLUSION There have been changes in practice since the publication of the previous guidelines in 2000. Computed tomography of the chest with intravenous contrast is strongly recommended to diagnose clinically significant BTAI. Endovascular repair is strongly recommended for patients without contraindications. Delayed repair of BTAI is suggested, with the stipulation that effective blood pressure control must be used in these patients.
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20
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Bottet B, Bouchard F, Peillon C, Baste JM. When and how should we manage thoracic aortic injuries in the modern era? Interact Cardiovasc Thorac Surg 2016; 23:970-975. [PMID: 27572614 DOI: 10.1093/icvts/ivw247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated. All five meta-analyses reported a reduction in mortality with thoracic endovascular aortic repair (TEVAR) compared with open repair (OR), but only four found the same benefit on paraplegia rate. Similarly, the two prospective and four retrospective studies showed significantly lower mortality with TEVAR than with OR. Only one study (a meta-analysis) reported a significantly lower stroke rate with TEVAR than with OR, whereas the 13 others reported a similar or even higher stroke rate. Other complication rates were identical. Four studies demonstrated that non-operative management (NOM) as a treatment option for BTAI was associated with increased mortality, even if it has declined in recent years. One study emphasized that some cases with minimal aortic injuries (Grade I and II on CT scan) could benefit from NOM. Regarding the timing of repair, only three studies analysed outcomes of delayed repair and reported significantly lower mortality than for early repair. We conclude that with lower mortality and similar overall complications including paraplegia but higher stroke rate, TEVAR is the most suitable treatment for BTAI in the modern era, where expertise exists, especially for cases of multiple associated injuries and in the older age group. Delayed aortic repair can be proposed based on CT scan analysis, but emergent repair should still be advocated for imminent free aortic rupture. NOM remains a therapeutic option but only with selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - François Bouchard
- Department of Thoracic and Cardiac Surgery, Rouen University Hospital, Rouen, France
| | - Christophe Peillon
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
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Khashram M, He Q, Oh TH, Khanafer A, Wright IA, Vasudevan TM, Lo ASN, Roake JA, Civil I. Late Radiological and Clinical Outcomes of Traumatic Thoracic Aortic Injury Managed with Thoracic Endovascular Aortic Repair. World J Surg 2016; 40:1763-70. [DOI: 10.1007/s00268-016-3457-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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23
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Liang M, Rong JJ, Sun JY, Wang XZ, Li F, Wang G, Liang YC, Han YL. Feasibility study of emergency intervention for vascular injury outside the hospital. Mil Med Res 2016; 3:36. [PMID: 27942389 PMCID: PMC5127049 DOI: 10.1186/s40779-016-0106-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive surgery in the field of traumatic vascular injury diagnosis and treatment has achieved good results. This study was designed to determine whether pre-hospital emergency intervention is feasible for vascular injury in a field intervention cabin under the condition of war or a disaster site. METHODS Different types of animal experiments of vascular injury intervention were performed in a field intervention cabin. Treatment capacity was evaluated by data collection, including duration of surgery, clinical evaluation, image clarity, and equipment handling. Environmental adaptability and mobility were evaluated by maneuverability and long-distance mobility. RESULTS A total of 56 surgeries (7 types) were performed in the field intervention cabin. Digital subtraction angiography (DSA) had good imaging performance. A total of 4800 km of long-distance mobility was performed, and all the equipment operated normally without any equipment failure. We participated in the medical service maneuver twice. The cabin unfolded and worked properly. There was no equipment damage during the medical service maneuver. CONCLUSIONS Use of a field intervention cabin under the conditions of war or disaster is feasible for pre-hospital emergency intervention of vascular injury.
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Affiliation(s)
- Ming Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Jing-Jing Rong
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Jing-Yang Sun
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Xiao-Zeng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Fei Li
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Yan-Chun Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016 China
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Liang M, Rong J, Sun J, Yao T, Xuan F, Zhao L, Li F, Wang X, Han Y. A mobile minimally invasive interventional shelter: a new answer to on-spot emergency treatment of large arterial injuries? Scand J Trauma Resusc Emerg Med 2015; 23:63. [PMID: 26338214 PMCID: PMC4559303 DOI: 10.1186/s13049-015-0144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severely destructive disasters can often lead to heavy casualties. Large arterial injury in disasters, particularly, often results in high mortality and morbidity. Although minimally invasive intervention has achieved positive effects in diagnosing and treating vascular injuries, it is still unavailable at the disaster area of any country due to lack of on-spot catheterization labs. This study aimed to test the feasibility of adopting interventional techniques to treat haemorrhage of large arterial injuries in remote and austere wild environments after severely destructive disasters, by using a new mobile intervention suite we developed--the mobile minimally invasive interventional shelter (MIS). METHODS Large animal models of aortic and femoral arterial injuries were established using a newly developed medium vehicle-mounted digital subtraction angiography (DSA) machine in MIS. The endovascular stent-graft exclusion and balloon occlusion combined with surgical hemostasis were performed respectively following the protocols for rapid interventional therapy. The treatment capacity of the shelter was evaluated based on its stability, surgery duration and the clinical results. RESULTS AND DISCUSSION The stability of the medical devices in MIS directly relates to the efficiency and success rate of interventional treatment. The newly developed vehicle-mounted DSA machine showed good imaging performance and the operation of all equipments and devices in MIS were stable in interventional procedures. All the interventional treatments for large arterial injuries were performed smoothly. The average time for treating abdominal aortic injury and femoral arterial injury was 23 ± 11 and 55 ± 17 min, respectively. And the operation success rate reached 100 %. CONCLUSION It is feasible to perform interventional operations to control haemorrhage of large arterial injuries in MIS outside hospital. The MIS has a great potential to save patients from dying of hemorrhagic shock due to lack of effective treatment devices and approaches in remote and austere wild environments, such as in disaster areas.
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Affiliation(s)
- Ming Liang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Jingjing Rong
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Jingyang Sun
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Tianming Yao
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Fengqi Xuan
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Lijun Zhao
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Fei Li
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Xiaozeng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
| | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110016, China.
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Challoumas D, Dimitrakakis G. Blunt Thoracic Aortic Injuries: New Perspectives in Management. Open Cardiovasc Med J 2015; 9:69-72. [PMID: 26312081 PMCID: PMC4541313 DOI: 10.2174/1874192401509010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/20/2015] [Accepted: 04/02/2015] [Indexed: 01/16/2023] Open
Abstract
Blunt thoracic aortic injuries (BTAIs) present a great challenge because of their potentially fatal outcomes. Recent advancements in their management have proved to be beneficial in terms of various parameters, including mortality and complications. Endovascular repair is now the treatment of choice in most centres and is continuously replacing the traditional open surgical method. We present a mini-review of the most recent relevant literature that briefly describes the major shifts in the diagnosis and treatment of BTAIs and compares the outcomes of the conventional surgical approach to those of the endovascular method for the definitive repair of these injuries. Although both the reviewed literature and the most recently published guidelines are in support of the use of the endovascular approach, as short and midterm results are promising, its long-term outcomes still remain in question.
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Affiliation(s)
- Dimitrios Challoumas
- Department of Upper GI Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, Univers ity Hospital of Wales, Heath Park Campus, Cardiff, CF 14 4XW, UK
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Challoumas D, Dimitrakakis G. Advances in the treatment of blunt thoracic aortic injuries. Injury 2015; 46:1431-9. [PMID: 25467824 DOI: 10.1016/j.injury.2014.10.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023]
Abstract
Blunt thoracic aortic injuries, even though rare in incidence, carry significant mortality rates and their management still remains challenging. There have been major shifts in diagnosing and treating these injuries in the last 5 decades, which proved to be beneficial in terms of mortality and complications. Endovascular repair has been increasingly used for definitive treatment and its outcomes appear to be at least equally safe and effective as those of open repair. We present a balanced review of the relevant literature regarding the most appropriate approach and definitive treatment of these pathological entities. Based on the studies analyzed, endovascular repair is increasingly being established as the choice of treatment, however, the conventional open surgical approach still remains a safe method for severe injuries; the mortality, complication rates and proven longterm results of the latter are continuously improving. Additionally, delayed repair, where appropriate, seems to be a safe option with very low mortality rates. Despite the encouraging short and midterm outcomes reported, endovascular treatment needs to be assessed in the longterm for more accurate conclusions to be drawn about its durability and safety.
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Affiliation(s)
- Dimitrios Challoumas
- Cardiff University School of Medicine, Heath Park Campus, University Hospital of Wales, Cardiff CF14 4XW, UK.
| | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park Campus, Cardiff CF14 4XW, UK
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Traumatisme thoracique : prise en charge des 48 premières heures. ANESTHESIE & REANIMATION 2015. [DOI: 10.1016/j.anrea.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ferrada P, Anand RJ, Aboutanos M, Ivatury R. Catheter-based endovascular damage-control (CDET): current status and future directions. World J Surg 2014; 38:330-4. [PMID: 24081541 DOI: 10.1007/s00268-013-2263-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Endovascular technology during the past decade has introduced innovative strategies to manage vascular trauma. The purpose of this study was to evaluate the current use catheter-based endovascular damage-control techniques (CDET) in North, Central, and South America. METHODS A survey was sent to the presidents of local societies in Latin America, members of the board, and past presidents of the Pan-American Trauma Society. The survey was sent using the Research Electronic Data Capture collection tool. RESULTS A total of 67 surveys were sent with an 85 % response rate. Surgeons from 15 countries participated in the survey. All of the centers in North America had capabilities to perform these procedures. In none of these centers, however, were they performed by trauma and acute care surgeons. In Central and South America, 64 % of the surgeons responded that they have an interventional radiology service, and in 56 % of the cases, trauma and acute care surgeons were already performing CDET. Eight-eight percent of those surveyed thought that the addition of CDET to trauma would improve patient care; 86 % would be interested in further training in this technique if such programs were available. Finally, 68 % thought that the addition of CDET would help the field of acute care surgery and trauma financially. CONCLUSIONS CDET is being performed already by trauma and acute care surgeons in Latin American countries. More research is necessary to evaluate the role of the trauma surgeon in the endovascular suite as well as training requirements.
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Affiliation(s)
- Paula Ferrada
- Trauma, Critical Care and Emergency Surgery, West Hospital, Virginia Commonwealth University, P.O. Box 980454, 15th Floor East, 1200 E. Broad Street, Richmond, VA, 23298, USA,
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 2813] [Impact Index Per Article: 281.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Applicability and Mid-Term Results of Endovascular Treatment for Descending Thoracic Acute Aortic Syndromes. Ann Vasc Surg 2013; 27:1029-35. [DOI: 10.1016/j.avsg.2012.10.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 11/24/2022]
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Harvey J, West A. The right scan, for the right patient, at the right time: The reorganization of major trauma service provision in England and its implications for radiologists. Clin Radiol 2013; 68:871-86. [DOI: 10.1016/j.crad.2013.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 01/02/2013] [Accepted: 01/08/2013] [Indexed: 12/30/2022]
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Watanabe KI, Fukuda I, Asari Y. Management of traumatic aortic rupture. Surg Today 2013; 43:1339-46. [PMID: 23338596 DOI: 10.1007/s00595-012-0471-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/26/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Ken-ichi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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